Hostility in the Dental Practice May Escalate if Left Unchecked

Traffic, inflation, political upheaval, family struggles and even the weather make the list of common reasons that stress levels are high and patience very low. Regardless of these external stressors or how different individuals manage their frustrations, dental professionals deserve a working environment that is free from hostile interactions. Practice leaders, therefore, have an obligation to foster a culture of respect and clear communication.

The Dentists Insurance Company’s Risk Management Advice Line receives a substantial number of calls every month regarding confrontational patients or employees. One call received by the Advice Line really illustrates how negative experiences in the practice can escalate into serious issues and even hostile workplace claims.

A Case Study in Confrontation

The caller said her practice’s situation began when the receptionist called the mother of a new pediatric patient to schedule a first appointment. The receptionist felt the parent was acting unpleasantly, as she was demanding a specific appointment time and pushing back on nearly every available date and time offered to her.

The parent and child presented to the first appointment and the same receptionist greeted them in a friendly and welcoming manner. When asked to complete new patient forms, the parent complained about the amount of paperwork needing completion and having to provide a copy of her identification. She expressed that she was in a rush and wanted to be out of the office within 45 minutes.

The receptionist informed the parent that an assistant would call her child back as soon as the check-in process was complete. The parent rolled her eyes and replied, “This is ridiculous.” Despite this reaction, the receptionist remained polite.

Instead of completing the child’s medical history, the parent made a call from her mobile phone and spoke in a way the receptionist described as loud and obnoxious. Seeing that the parent had stopped filling out the forms and was focusing her attention on her phone call, the receptionist reiterated that once the health history was complete, she could call the patient to the back. The parent angrily replied, “What does it look like I am doing?”

The receptionist, feeling frustrated, sought out the office manager, explained the way the parent was speaking to her and asked for some assistance with the front desk. The office manager advised her to just ignore the parent’s attitude and remain professional. The receptionist was still upset and felt humiliated by the way the parent spoke to her.

Once the dental assistant was able to call the patient back, the appointment seemed to go well. The dentist diagnosed treatment and the receptionist scheduled the next visit. The patient presented at the next visit and once again the parent was in a hurry, demanding the receptionist “hurry up” and get her child to the back.

The dentist completed treatment and the patient was dismissed. After the dental benefits plan was billed, a balance from the deductible was due. At the following visit, when the receptionist informed the parent of the balance due, the parent yelled, “Do you people know how to bill insurance?”

Thereafter, every appointment and interaction with this parent was unpleasant and difficult for the receptionist, who seemed to be a target for the parent’s open hostility. Other patients in the lobby observed how this parent treated the receptionist and expressed their disapproval of the parent’s behavior. Some even remarked, “You shouldn’t have to deal with that.” The office manager witnessed it as well but did not intervene to stop the parent’s behavior or defend the receptionist.

The parent became even more abusive over time and the receptionist expressed that she was feeling bullied. The receptionist eventually made a formal complaint to the dentist, saying she was not only experiencing extreme anxiety, but also felt fearful and depressed at work and needed to go home. The receptionist asked the dentist to file a workers’ compensation claim for her distress.

Taking Steps to Prevent a ‘Hostile Work Environment’

After hearing the details of this specific situation, a risk management analyst determined that the office manager and the dentist failed to take action and protect the employee from a hostile work environment.

The analyst explained that the dentist has a responsibility to provide a safe environment free from hostility and that the proper way to handle the situation would have been to stop the parent’s behavior from the very first appointment. Because that did not happen, the analyst recommended that the dentist formally dismiss the patient and comply with the receptionist’s request to open a workers’ compensation claim.

The analyst also discussed the importance of office culture with the caller. Some personalities may not be a good fit for the practice, and sometimes a relationship cannot be established. In these instances, the practice owner must take action and dismiss the patient from the practice as long as the reasons for doing so are nondiscriminatory. The staff needs to respect patients, but patients must also respect them.

Additionally, the analyst reminded the caller that one of the most important steps a practice owner can take is to document an issue was discussed and any steps taken to solve the problem. Documentation should be retained in the employee file in the event there is a complaint to the U.S. Department of Labor for a hostile work environment.

Learning Better Ways to Handle Conflict

In this situation, one option would have been for the office manager to discuss the matter with the parent in private, informing the parent that communicating with staff in this manner was not acceptable. The parent should have been advised that if she presented with hostility again, the practice would be forced to dismiss the patient. The office manager should always lead by example and be trusted as a safe resource to whom employees can turn. If there is not an on-site office manager, the dentist should take on the role and offer a resolution. If the patient is not midtreatment, withdraw from further services by notifying the parent first and then by sending a dismissal letter to the patient’s home address. It is important to have objective notes regarding any interactions, using quotation marks to document specific relevant statements made by the patient and, as in this instance, the parent or, in some cases, another staff member who is behaving in a hostile manner.

Set clear expectations for professionalism, communication and interpersonal interaction among staff members and between staff and patients. When communication breakdowns happen, the environment can quickly become toxic. However, it’s the role of the practice owner to facilitate a safe environment free of fear of judgement or retaliation so staff members feel comfortable voicing their concerns. TDIC's analysts suggest  creating a confirming communication climate by developing positive communication skills that de-escalate conflict and foster feelings of support and cooperation.

Every patient will require a different level of care and attention, but it is never acceptable for the patient to be abusive to any member of the dental team. Taking action in a prompt manner is important, as it prevents the issue from potentially escalating or becoming a chronic problem. Reach out to the Risk Management Advice Line when you have practice concerns. TDIC's risk management analysts provide assistance navigating challenges and finding solutions before potential risks escalate.

TDIC’s Risk Management Advice Line is a benefit to TDIC policyholders. To schedule a consultation with an experienced risk management analyst, visit tdicinsurance.com/RMconsult or call 1.877.269.8844.